Reduction In Left Ventricular Mass Index Research Articles

Early reverse remodeling by echocardiography after transcatheter aortic valve implantation.

Oslo University Hospital is a tertiary center conducting a significant number of transcatheter aortic valve implantation (TAVI) procedures per year. In this follow-up MediPace study, we aimed to investigate early echocardiographic changes in systolic and diastolic functions after TAVI in these patients. All patients enrolled in the previous study were contacted 3 months after TAVI for echocardiographic evaluation. Detailed echocardiography was performed 3.5±1.6 months after TAVI, and compared with baseline evaluations. A total of 101 patients were analyzed. Mean age was 80.1±6.8 years and 40% of the patients were female. We observed a significant improvement in global longitudinal strain (GLS) (pre-TAVI -16.8±4.1%, post-TAVI -17.8±3.6%, p <.001), with no notable change in LVEF. More than half of the patients (52%) experienced a significant reverse remodeling with ≥10% decrease in left ventricular mass index (LVMi) following TAVI (pre-TAVI 123.6±32.1vs. 109.7±28.9g/m2 post-TAVI, p <.001). Pre-TAVI LVMi was a positive predictor, whereas history of HT was a negative predictor of LVMi reduction. There was no significant improvement in diastolic function following TAVI. Highest degree of paravalvular leakage was mild to moderate and was observed in only 2%. A significant improvement in GLS and LVMi was found following TAVI. History of hypertension and baseline LVMi were predictors of LVMi change. There was no notable change in diastolic function, including left atrial strain.

EFFECTS OF ALLISARTAN ON URIC ACID, LEFT ATRIAL, LEFT VENTRICULAR AND ARTERY STIFFNESS IN MILD-TO-MODERATE ESSENTIAL HYPERTENSION

Objective: Our study aimed to explore the effects of allisartan on blood pressure, uric acid (UA), left atrial, left ventricular structure and function and artery stiffness in mild-to-moderate essential hypertension. Design and method: Our study is a randomised, double-blind, crossover design involving 98 patients with mild-to-moderate essential hypertension. Participants were administered allisartan (240mg) or olmesartan (20mg) once daily for 12 weeks each in varying sequences. Results: Both allisartan and olmesartan led to a significant decrease in systolic blood pressure (SBP) levels from baseline, with no significant difference between the two drugs (δ= 6.5mmHg, P&lt;0.001 and δ= 5.64mmHg, P=0.002). Notably, allisartan exhibited a more pronounced reduction in diastolic blood pressure compared to olmesartan (δ= 3.66mmHg, P=0.001), with superior efficacy in lowering diastolic blood pressure (DBP) (δ= 3.39mmHg, P=0.016). Allisartan significantly dropped serum UA levels (δ= 26.37 μmol/L, P&lt;0.001), whereas olmesartan did not achieve a significant reduction compared to allisartan (δ= 33.63 μmol/L, P&lt;0.001). In terms of cardiac and artery stiffness, allisartan demonstrated significant reductions in left atrial volume index (LAVI) (δ= 2.86 ml/m2, P&lt;0.001), left ventricular mass index (LVMI) (δ= 4.82 g/m2, P=0.010) and ankle-brachial pulse wave velocity (baPWV) (δ= 154.49 cm/s, P&lt;0.001), all-surpassing olmesartan significantly (all P&lt;0.01). Conclusions: In conclusion, compared to olmesartan, allisartan demonstrates significant reductions in serum UA, blood pressure, LAVI, LVMI and baPWV in patients with mild to moderate essential hypertension. This study provides new evidence supporting the efficacy of allisartan in treating mild-to-moderate essential hypertension and reducing serum UA levels in this population.

Echocardiographic findings following renal sympathetic denervation for treatment resistant hypertension, the ReShape CV-risk study

Objective The aim of this study was to describe and compare echocardiographic findings before renal sympathetic denervation (RDN) and 6 and 24 months after the procedure. Materials and methods Patients with treatment resistant hypertension (TRH) were included in this non-randomised intervention study. RDN was performed by a single experienced operator using the Symplicity Catheter System. Echocardiographic measurements were performed at baseline, and after 6 and 24 months. Results The cohort consisted of 21 patients with TRH, with a mean systolic office blood pressure (BP) of 163 mmHg and mean diastolic BP 109 mmHg. Mixed model analysis showed no significant change in left ventricular (LV) mass index (LVMI) or left atrium volume index (LAVI) after the RDN procedure. Higher LVMI at baseline was significantly associated with greater reduction in LVMI (p < 0.001). Relative wall thickness (RWT) increased over time (0.48 mm after two years) regardless of change in BP. There was a small but significant reduction in LV end-diastolic (LVIDd) and end-systolic (LVIDs) diameters after RDN, with a mean reduction of 2.6 and 2.4 mm, respectively, after two years. Progression to concentric hypertrophy was observed only in in patients who did not achieve normal BP values, despite BP reduction after RDN. Conclusion There was no reduction of LV mass after RDN. We found a small statistically significant reduction in LVIDd and LVIDs, which together with increase in RWT can indicate progression towards concentric hypertrophy. BP reduction after RDN on its own does not reverse concentric remodelling if target BP is not achieved.

Age-dependent implications of left ventricular hypertrophy regression in patients with hypertension.

Left ventricular hypertrophy (LVH) is a significant risk factor for cardiovascular mortality and morbidity in patients with hypertension. However, the effect of age on LVH regression or persistence and its differential prognostic value remain unclear. Therefore, we investigated the clinical implications of LVH regression in 1847 patients with hypertension and echocardiography data (at baseline and during antihypertensive treatment at an interval of 6-18 months) according to age. LVH was defined as a left ventricular mass index (LVMI) > 115 g/m2 and >95 g/m2 in men and women, respectively. LVH prevalence at baseline was not different according to age (age < 65 years: 42.6%; age ≥65 years: 45.7%; p = 0.187), but LVH regression was more frequently observed in the younger group (36.4% vs. 27.5%; p = 0.008). Spline curves and multiple linear regression analysis showed a significant relationship between reductions in systolic blood pressure and LVMI in the younger group (β = 0.425; p < 0.001), but not the elderly group (β = 0.044; p = 0.308). LVH regression was associated with a lower risk of the study outcome (composite of cardiovascular death and hospitalization for heart failure) regardless of age. In conclusion, the association between the reduction in blood pressure and LVH regression was prominent in patients with age < 65 years, but not in those with age ≥65 years. However, an association between LVH regression and lower risk of cardiovascular death and hospitalization for heart failure was observed regardless of patient age, suggesting the prognostic value of the LVH regression not only in the younger patients but also in elderly patients.

Abstract 13395: Dapagliflozin Reduces Myocardial Sodium Content and Correlates With Reverse Cardiac Remodeling in Nondiabetic Patients With Heart Failure and Preserved Ejection Fraction (Dapa-Sodium)

Introduction: Myocardial sodium overload is a major determinant of adverse cardiac remodeling in heart failure (HF). Sodium tissue content by 23Na magnetic resonance imaging (23Na-MRI) has been validated in human studies. SGLT-2 inhibition blocks sodium reabsorption in renal proximal tubular cells with remarkable cardiovascular outcomes in HF due to mechanisms not yet fully understood. Hypothesis: SGLT-2 inhibition will decrease myocardial sodium content and it will correlate with reverse remodeling in HFpEF. Aim: To determine whether Dapagliflozin leads to decreased myocardial sodium content and reverses pathological hypertrophy in HFpEF. Methods: Prospective, single-center, open-label study of sixty nondiabetic outpatients with HFpEF underwent baseline 23Na-MRI and initiated with dapagliflozin 10 mg once daily according to GDMT. Absolute changes in myocardium relative sodium signal intensity (rSSI) and left ventricular mass index (LVMi) were analyzed from baseline and at 3-month follow-up with 23Na-MRI. Results: All patients exhibited significantly high baseline myocardium rSSI [0.32 (0.28, 0.34)]; 66% above median [0.24 (0.20, 0.27), P = 0.004], decreasing -30% to [0.27 (0.22, 0.30), P&lt;0.001] at 3 months with Dapagliflozin therapy. These changes were correlated with a significant reduction in LVMi of -13 g/m 2 [from 84 g/m 2 (72, 120) to 71 g/m 2 (63, 95), P&lt;0.001]. Conclusions: Dapagliflozin reduces myocardial sodium content and reverses pathological hypertrophy in patients with HFpEF. These findings suggest that SGLT-2 inhibition acts directly on cardiomyocytes and explains the cardioprotective effects demonstrated though large randomized trials.

Stricter Blood Pressure Control Is Associated With Lower Left Ventricular Mass in Children After Kidney Transplantation: A Longitudinal Analysis of the 4C-T Study.

We assessed the effect of blood pressure (BP) control on left ventricular mass index (LVMI) and left ventricular hypertrophy (LVH). Ninety-six patients (64 males) ≥9 months post-kidney transplantation from the 4C-T (Cardiovascular Comorbidity in Children with Chronic Kidney Disease and Transplantation) study were analyzed longitudinally (mean follow-up, 2.6±1.3 years). Cumulative systolic blood pressure (SBP)/diastolic BP exposure was calculated as a time-averaged area under the curve and categorized: ≤50th, 50th to ≤75th, 75th to ≤90th, and >90th percentile (pct). We performed adjusted linear and logistic mixed models for LVMI and LVH, respectively. At baseline, LVMI was 49.7±12.7g/m2.16 with 64% (n=61) kidney transplantation recipients displaying LVH. Compared with patients with cumulative SBP exposure >90th pct, patients with cumulative SBP of 50th to ≤75th showed a significant LVMI reduction of -5.24g/m2.16 (P=0.007). A similar tendency was seen for cumulative SBP≤50th (β=-3.70 g/m2.16; P=0.067), but patients with cumulative SBP of 75th to ≤90th pct showed no reduction. A post hoc analysis in patients with cumulative SBP≤75th revealed that median SBP exposure was at 57.5th pct. For cumulative diastolic BP, a significant LVMI reduction was seen in all 3 categories ≤90th pct compared with patients >90th pct. Patients with cumulative SBP of ≤50th or 50th to ≤75th pct showed 79% or 83% lower odds of developing LVH, respectively. Patients with cumulative diastolic BP ≤50th showed a tendency of 82% lower odds for LVH (95% CI, 0.03-1.07). Stricter BP control led to regression of LVMI and LVH. Our data suggest a BP target below the 60th pct, which needs to be substantiated in a randomized controlled trial.

#6300 CHANGES IN ECHOCARDIOGRAPHIC INDICES FOLLOWING KIDNEY TRANSPLANTATION: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Background and Aims Cardiovascular disease is the leading cause of death in ESKD and uremic cardiomyopathy contributes significantly to the increased cardiovascular risk in these patients. Kidney transplantation is associated with improved survival compared to dialysis. This systematic review and meta-analysis (CRD42022371202) aims to assess the changes in echocardiographic indices in patients before and following kidney transplantation Method We included studies in adult subjects with echocardiographic assessments before (baseline) and following kidney transplantation (&amp;gt;1 month follow-up). The primary outcome measure was left-ventricular mass index (LVMI). Literature search involved PubMed, Web-of-Science and Scopus databases, manual search of article references and grey literature. Results From 6463 records initially retrieved, 35 studies with a total of 2692 participants were included in the final quantitative meta-analysis. From 30 studies (2211 patients) reporting the primary outcome, LVMI was significantly decreased after kidney transplantation compared to pre-transplantation values [WMD -21.16 g/m2, 95%CI(-27.21, -15.12), I2 = 88%, P&amp;lt;0.001]. In subgroup analysis, higher differences were evident among 6 studies (N = 163) evaluating LVMI&amp;lt;6 months after kidney transplantation [WMD -41.54 g/m2, 95%CI (-51.31, -31.78), I2 = 13%, P&amp;lt;0.001] and lower differences among 24 studies (N = 2048) evaluating LVMI &amp;gt;6 months after kidney transplantation [WMD -16.64 g/m2, 95%CI(-22.79, -10.49), I2 = 88%, P&amp;lt;0.001]. In sensitivity analyses, patients receiving kidney from living kidney donors (WMD; -76.90 g/m2, 95%CI (-122.13, -31.67), I2 = 88%, P&amp;lt;0.001) and those on hemodialysis before KTx [WMD;-33.76 g/m2, 95%CI (-51.51, -16.00), I2 = 92% P&amp;lt;0.001] presented higher LVMI reductions following transplantation. Conclusion Kidney transplantation is associated with significant reductions in LVMI compared to the pre-transplantation levels. This could be another factor contributing to the lower cardiovascular risk observed in KTRs compared to dialysis patients.

#5209 ALGALSIDASE-BETA STABILIZES RENAL AND CARDIAC INVOLVEMENT: A FOLLOW-UP STUDY OF A BRAZILIAN FABRY DISEASE FAMILY

Abstract Background and Aims Fabry Disease (FD) is a multisystemic disorder that affects the function of major organs, such as the kidneys, the heart and the central nervous system, reducing the quality of life and leading ultimately to premature death. Early diagnosis and timely treatment are the cornerstones to change the natural history of this disorder. Method To evaluate clinical, laboratory and renal histological profiles of FD patients with a classic pathogenic variant (p.G35V), identified by targeted screening in hemodialysis patients followed by family screening, who were under enzyme replacement therapy (ERT), algalsidase-beta (0.1 mg/kg/e.o.w), for at least 48 months. Kidney biopsy was performed at baseline. Glomerular filtration rate, estimated according to the CKD-Epi equation, 24h-urinary protein and albumin were measured annually. Cardiac manifestations were evaluated by eletrocardiogram, transthoracic echocardiography (TTE) or magnetic resonance imaging (cMRI) at baseline and at the end of the study. cMRI was not performed in the index patient, due to CKD 5D, and in a pregnant female patient. Results Nine patients (age: 33.8±12.3 years) were followed-up for 80.67±5.43 months. Their main clinical manifestations were hypohidrosis (67%) gastrointestinal symptoms (56%), cornea verticilata and acroparesthesia (100%). Angiokeratomas were present only in males (100%). Five (56%) and 3 (33%) patients presented CKD G1 and G2, respectively. Only the index case presented CKD G5D. Short PR interval was observed in 44.4%. LVH was detected by TTE in 2 patients (index case and a 46-years old female); whereas based on cMRI no patient had LVH and one female had myocardial fibrosis. Patients received ERT for 70.22±12.92 months, together with adequate adjunctive therapy. eGFR and proteinuria / albuminuria remained stable during the follow-up in both sexes. Female patients presented a mean reduction of LV mass index of 9.73g/m2 (CI95%: -26.9 - 6.8). Patients who started ERT older than 30 years tended to have a higher interventricular septal thickness at the end of the follow-up (8.4 ± 2.2 vs 10.0 ± 2.7 mm; P = .08). Concerning the kidney biopsy findings, patients with higher proteinuria presented more global glomeruli sclerosis; and mild interstitial fibrosis (5%) could be detected even among young patients with normal albuminuria and eGFR. There was a significant correlation between baseline global glomeruli sclerosis and albuminuria at baseline (r=0.9; P = .01) and at the end of the follow-up (r=0.87; P = .01); and between baseline interstitial fibrosis and proteinuria at the end of the follow-up (r=0.80; P = .03). Conclusion Females with a pathogenic variant (p.G35V) for FD may develop cardiac and renal injury. FD-related renal histological changes and chronic tissue damage may be present before clinical and laboratory signs of renal dysfunction. Persistence of proteinuria during ERT might be related to the presence of interstitial fibrosis. Treatment with ERT may stabilize renal and cardiac involvement in FD. Regular monitoring and adequate pathogenetic and adjunctive treatment should be offered to FD patients of both sexes. Kidney biopsy is an important tool to evaluate pre-clinical renal involvement. Timely treatment may potentially change the natural history of the disease.

#4540 LONG-TERM OUTCOMES AFTER RENAL DENERVATION: A FOLLOW-UP OF 5 YEARS

Abstract Background and Aims Arterial hypertension is a significant cause of cardiovascular morbimortality worldwide. Adequate blood pressure control constitutes a crucial tool to prevent the enduring end-organ damage inflicted by hypertension and, consequently, its high burden of disease. Resistant hypertension may be particularly challenging to address: in this field, denervation of the renal sympathetic nerves is developing as a promising despite controversial therapy. Our goal was to study long-term outcomes in a cohort of patients with resistant hypertension submitted to renal denervation. Method We conducted a retrospective, single-centre study amongst patients with resistant hypertension who underwent renal denervation between July 2011 and July 2022. All patients routinely underwent blood and urine testing, 24-hour ambulatory blood pressure monitoring (ABPM) and echocardiographic evaluation every 6 to 12 months after the procedure. We collected several demographic, clinical and laboratory variables, and analysed outcomes at 5 years of follow-up using SPSS software. Results 78 patients were submitted to renal denervation in our centre, 53% of which (n = 41) were male. There were no reported complications related to the procedure. At 5 years of follow-up, there were different types of responders. In ABPM, 61% of the patients showed a decrease in mean systolic blood pressure (SBP), with a median reduction of 16 mmHg (IQR 16.5). In 46% of patients, there was a reduction in albumin/creatinine ratio (ACR), with a median decrease of 17.63 mg/g (IQR 120.67). Before renal denervation, 30 patients (38.5%) had an ACR above 30 mg/g, while after 5 years the number of patients with ACR in this range was 21 (26.9%). In echocardiographic evaluation, 70% of the patients evidenced a decrease in left ventricular mass index (LVMI) with a median reduction of 20 g/m2 (IQR 41). These results are summarised in Figure 1. In total, 70% of the patients were considered responders to renal denervation, either through a reduction in mean SBP in ABPM, in LVMI, in ACR or simultaneously in all three variables. Additionally, the reduction in mean SBP in ABPM, LVMI and ACR proved to be independent variables, both in Spearman tests and binary logistic linear regression (nonsignificant p-values). 77% of the patients were prescribed less antihypertensive drugs after follow-up, with a median reduction of 2 drugs (IQR 2). Conclusion Our study identified a significant percentage of responders to renal denervation, evidenced by an improvement in one or more variables associated with blood pressure control and hypertension-mediated end-organ damage, without any safety issues to report. It is also important to emphasize that the observed reduction in ACR and LVMI was independent of the reduction in SBP. This finding suggests that renal denervation might have a direct effect on albuminuria and left ventricular hypertrophy, instead of solely as an indirect result of the control of blood pressure. Hence, while further studies are necessary to support this evidence, the results nevertheless raise hope for the therapeutic potential of renal denervation in patients with resistant hypertension.

CHANGES IN ECHOCARDIOGRAPHIC INDICES FOLLOWING KIDNEY TRANSPLANTATION: A SYSTEMATIC REVIEW AND META-ANALYSIS

Objective: Cardiovascular disease is the leading cause of death in ESKD and uremic cardiomyopathy contributes significantly to the increased cardiovascular risk in these patients. Kidney transplantation is associated with improved survival compared to dialysis. This systematic review and meta-analysis (CRD42022371202) aims to assess the changes in echocardiographic indices in patients before and following kidney transplantation Design and method: We included studies in adult subjects with echocardiographic assessments before (baseline) and following kidney transplantation (&gt;1 month follow-up). The primary outcome measure was left-ventricular mass index (LVMI). Literature search involved PubMed, Web-of-Science and Scopus databases, manual search of article references and grey literature. Results: From 6463 records initially retrieved, 35 studies with a total of 2692 participants were included in the final quantitative meta-analysis. From 30 studies (2211 patients) reporting the primary outcome, LVMI was significantly decreased after kidney transplantation compared to pre-transplantation values [WMD -21.16 g/m2, 95%CI(-27.21, -15.12), I2 = 88%, P &lt; 0.001]. In subgroup analysis, higher differences were evident among 6 studies (N = 163) evaluating LVMI &lt; 6 months after kidney transplantation [WMD -41.54 g/m2, 95%CI (-51.31, -31.78), I2 = 13%, P &lt; 0.001] and lower differences among 24 studies (N = 2048) evaluating LVMI &gt;6 months after kidney transplantation [WMD -16.64 g/m2, 95%CI(-22.79, -10.49), I2 = 88%, P &lt; 0.001]. In sensitivity analyses, patients receiving kidney from living kidney donors (WMD; -76.90 g/m2, 95%CI (-122.13, -31.67), I2 = 88%, P &lt; 0.001) and those on hemodialysis before KTx [WMD;-33.76 g/m2, 95%CI (-51.51, -16.00), I2 = 92% P &lt; 0.001] presented higher LVMI reductions following transplantation. Conclusions: Kidney transplantation is associated with significant reductions in LVMI compared to the pre-transplantation levels. This could be another factor contributing to the lower cardiovascular risk observed in KTRs compared to dialysis patients

Intensive compared with less intensive blood pressure control to prevent adverse cardiac remodelling in children with chronic kidney disease (HOT-KID): a parallel-group, open-label, multicentre, randomised, controlled trial

Optimal target blood pressure to reduce adverse cardiac remodelling in children with chronic kidney disease is uncertain. We hypothesised that lower blood pressure would reduce adverse cardiac remodelling. HOT-KID, a parallel-group, open-label, multicentre, randomised, controlled trial, was done in 14 clinical centres across England and Scotland. We included children aged 2-15 years with stage 1-4 chronic kidney disease-ie, an estimated glomerular filtration rate (eGFR) higher than 15 mL/min per 1·73 m2-and who could be followed up for 2 years. Children on antihypertensive medication were eligible as long as it could be changed to angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) if they were not already receiving these therapies. Participants were randomly assigned (1:1) to standard treatment (auscultatory office systolic blood pressure target between the 50th and 75th percentiles) or intensive treatment (systolic target <40th percentile) by the chief investigator using a rapid, secure, web-based randomisation system. ACE inhibitors or ARBs were used as first-line agents, with the dose titrated every 2-4 weeks to achieve the target blood pressure levels. The primary outcome was mean annual difference in left ventricular mass index (LVMI) by echocardiography measured by a masked observer and was assessed in the intention-to-treat population, defined as all the children who underwent randomisation irrespective of the blood pressure reached. Secondary and safety outcomes were the differences between groups in mean left ventricular relative wall thickness, renal function, and adverse effects and were also assessed in the intention-to-treat population. This trial is registered with ISRCTN, ISRCTN25006406. Between Oct 30, 2012, and Jan 5, 2017, 64 participants were randomly assigned to the intensive treatment group and 60 to the standard treatment group (median age of participants was 10·0 years [IQR 6·8-12·6], 69 [56%] were male and 107 [86%] were of white ethnicity). Median follow-up was 38·7 months (IQR 28·1-52·2). Blood pressure was lower in the intensive treatment group compared with standard treatment group (mean systolic pressure lower by 4 mm Hg, p=0·0012) but in both groups was close to the 50th percentile. The mean annual reduction in LVMI was similar for intensive and standard treatments (-1·9 g/m2·7 [95% CI -2·4 to -1·3] vs -1·2 g/m2·7 [-1·5 to 0·8], with a treatment effect of -0·7 g/m2·7 [95% CI -1·9 to 2·6] per year; p=0·76) and mean value in both groups at the end of follow-up within the normal range. At baseline, elevated relative wall thickness was more marked than increased LVMI and a reduction in relative wall thickness was greater for the intensive treatment group than for the standard treatment group (-0·010 [95% CI 0·015 to -0·006] vs -0·004 [-0·008 to 0·001], treatment effect -0·020 [95% CI -0·039 to -0·009] per year, p=0·0019). Six (5%) participants reached end-stage kidney disease (ie, an eGFR of <15 mL/min per 1·73 m2; three in each group) during the course of the study. The risk difference between treatment groups was 0·02 (95% CI -0·15 to 0·19, p=0·82) for overall adverse events and 0·07 (-0·05 to 0·19, p=0·25) for serious adverse events. Intensive treatment was not associated with worse renal outcomes or greater adverse effects than standard treatment. These results suggest that cardiac remodelling in children with chronic kidney disease is related to blood pressure control and that a target office systolic blood pressure at the 50th percentile is close to the optimal target for preventing increased left ventricular mass. British Heart Foundation.

Effect of metformin on left ventricular mass and functional parameters in non-diabetic patients: a meta-analysis of randomized clinical trials

BackgroundLeft ventricular hypertrophy is a common finding in patients with ischemic heart disease and is associated with mortality in patients with cardiovascular disease (CVD). Metformin, an antidiabetic drug, has been shown to reduce oxidative stress and left ventricular mass index (LVMI) in animal hypertrophy models. We summarized evidence regarding the effect of metformin on LVMI and LVEF.MethodsElectronic databases were searched for randomized clinical trials (RCTs) that used metformin in non-diabetic patients with or without pre-existing CVD. The standardized mean change using change score standardization (SMCC) was calculated for each study. The random-effects model was used to pool the SMCC across studies. Meta-regression analysis was used to assess the association of heart failure (HF), metformin dose, and duration with the SMCC.ResultsData synthesis from nine RCTs (754 patients) showed that metformin use resulted in higher reduction in LVMI after 12 months (SMCC = −0.63, 95% CI − 1.23; − 0.04, p = 0.04) and an overall higher reduction in LVMI (SMCC = −0.5, 95% CI − 0.84; − 0.16, p < 0.01). These values equate to absolute values of 11.3 (95% CI 22.1–0.72) and 8.97 (95% CI 15.06–2.87) g/m2, respectively. The overall improvement in LVEF was also higher in metformin users after excluding one outlier (SMCC = 0.26, 95% CI 0.03–0.49, P = 0.03) which translates to a higher absolute improvement of 2.99% (95% CI 0.34; 5.63). Subgroup analysis revealed a favorable effect for metformin on LVEF in patients who received > 1000 mg/day (SMCC = 0.28, 95% CI 0.04; 0.52, P = 0.04), and patients with HF (SMCC = 0.23; 95% CI 0.1; 0.36; P = 0.004). These values translate to a higher increase of 2.64% and 3.21%, respectively.ConclusionResults suggest a favorable effect for metformin on LVMI and LVEF in patients with or without pre-existing CVD. Additional trials are needed to address the long-term effect of metformin.Registration The study was registered on the PROSPERO database with the registration number CRD42021239368 (https://www.crd.york.ac.uk/prospero).

The Effect of Ascending Aortic Repair on Left Ventricular Remodeling

Left ventricular (LV) hypertrophy is common in patients with thoracic aortic diseases and is associated with increased long-term mortality. Thoracic aortic aneurysms are reported to increase LV afterload because of kinetic energy loss within the aneurysm sac, which may improve after surgical repair. However, LV afterload may also increase because of the stiffness of prosthetics used for aortic repair. We sought to investigate the long-term effect of surgical aortic repair with prostheses on postsurgical LV mass. We reviewed patients who underwent ascending aortic replacement with a prosthesis at our institution from January 2008 to December 2018. We calculated the LV mass index based on pre- and postoperative echocardiogram measurements. The primary outcome was the change in LV mass index 6 months after aortic repair. Patients aged &lt;18 years and those who had concomitant cardiac operations, severe aortic valve disease, or who had no echocardiographic data were excluded. Of 1,008 patients who underwent ascending aortic replacement, 134 (51 with acute aortic dissections) were included. The median baseline and follow-up LV mass index were 107 (90 to 135) g/m² and 101 (83 to 123) g/m², respectively. Overall, there was a significant reduction of LV mass index over time (p=0.03). LV mass index decreased in 77 patients (59%). Presentation due to acute aortic dissection (p=0.03) and baseline LV mass index (p &lt;0.001) were significant predictors of LV mass reduction. In conclusion, LV mass index may significantly decrease over time after the aortic repair, but the course is highly variable. The largest decrease occurred in patients who presented because of aortic dissections rather than for elective repair of aneurysms.

Surgical aortic valve replacement provides better left ventricular mass regression than transcatheter aortic valve replacement in patients with small aortic annulus.

This study aimed to evaluate the incidence of patient-prosthesis mismatch (PPM) and degree of left ventricular (LV) mass regression after surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) in patients with small aortic annulus (defined as annular diameter of ≤ 21mm). We retrospectively analyzed echocardiographic findings in total of 277 patients with aortic stenosis and small aortic annulus (63 underwent SAVR and 214 underwent TAVR) between October 2013 and March 2019. PPM was defined as an effective orifice area index (EOAI) ≤ 0.85 cm2/m2. LV mass regression was evaluated as percentage change in LV mass index (LVMI) from baseline to the 1-year follow-up. The median EOAI before discharge was slightly larger in the TAVR group than in the SAVR group (1.09 vs. 1.07 cm2/m2; P = 0.030). However, the incidence of PPM before discharge (9.4 vs. 12.7%; P = 0.438) and at the 1-year follow-up (11.7 vs. 11.1%; P = 0.901) was similar between groups. Mild or greater paravalvular leakage (PVL) after the procedure was more frequent in the TAVR group (11.7 vs. 0%; P = 0.002). Reduction in LVMI was significantly higher in the SAVR group (19.3 vs. 6.4%; P < 0.001). Multivariate analysis demonstrated that reduction in LVMI was positively associated with higher baseline transaortic pressure gradient (P < 0.001) and higher baseline LVMI (P < 0.001) and negatively associated with older age (P < 0.001) and mild or greater PVL (P < 0.001). SAVR provides better LV mass regression than TAVR with a comparable rate of PPM in patients with small aortic annulus.

PHARMACOLOGICAL TREATMENT OF ARTERIAL HYPERTENSION GUIDED BY PERIPHERAL OR CENTRAL BLOOD PRESSURE: COMPARISON OF THE TWO STRATEGIES IN THE INCIDENCE OF INTERMEDIATE OUTCOMES

Objective: To compare the parameters of central and peripheral blood pressure measurements, arterial stiffness, target organ damage (TOD), biochemical and renal profiles among participants who had the therapeutic strategy guided by central (CG) and peripheral (PG) blood pressure values. Design and method: Randomized study in two groups: CG and PG. Five visits were carried out, the first (V1) being selection and randomization followed by intermediate visits, every 3 months, to assess blood pressure and adjust antihypertensive drugs. The procedures performed in the initial and final visit (V5) were: measurement of central arterial pressure and pulse wave velocity (PWV) (mobil-o-graph) and peripheral (OMRON HEM1100), carotid ultrasound, echodopplercardiogram and laboratory tests. Paired and unpaired t and chi-square tests were used. Adopted significance level of 5% and a confidence interval of 95%. Results: A total of 59 participants were evaluated (30 from the CG and 29 from the PG). Age, BMI, central and peripheral blood pressure measurements, PWV, left ventricular mass index (LVMI), carotid intimal mean thickness, biochemical profile and glomerular filtration rate did not differ between the two groups (p &gt; 0.05) in randomization. The augmentation index (AIx) was higher in the CG than in the PG at randomization (27.3% ± 12.2% vs 20.3% ± 13.3% p 0.041). After 1 year of follow-up, in the analysis between the groups, the central diastolic pressure was lower in the CG (78.9mmHg ± 9.7mmHg vs 84.3 ± 10.4mmHg, p 0.024) and the difference in AIx between the groups ceased to exist. When intra-group comparisons were made before and after the intervention, a reduction in the PWV (p &lt; 0.001) and LVMI (p = 0.018) was observed in the CG. In PG there was an increase in PWV (p &lt; 0.001) and LVMI (p = 0.003). Conclusions: The intervention guided by central pressure, after 1 year of follow-up, was able to reduce the central diastolic pressure and correct the AIx parameter and, in the intra-group analysis, it promoted a reduction in PWV and LVMI. There was no difference between the two groups regarding the improvement of outcomes related to central and peripheral blood pressure, cardiac and vascular TOD, biochemical and renal profile.

Effect and correlation of patent vascular access flow on left ventricular hypertrophy in kidney transplant patients.

BackgroundPatency of vascular accesses (VA) is associated with left ventricular hypertrophy (LVH) in kidney transplant recipients (KTR). This level of VA flow (VAF) as related to LVH was assessed and an upward level of VA flow recommended for VA closure determined. This recommendation has not been previously reported.Methods123 KTR cohort patients were enrolled between August 2016 and December 2017 and their LVH and LV mass index (LVMI) by echocardiography and VAF by Doppler ultrasound were evaluated at baseline and for a 24-month follow-up period. Associations between VAF and LVH were adjusted for other factors.ResultsPatients with patent VA (55.3%) had significantly greater LVH (47.1 vs. 29.1%, an adjusted odds ratio 2.44, p = 0.03) and LVMI (112.15 ± 34.4 vs. 97.55 ± 23.55 g/m2, p = 0.009) when compared with the non-VA group. A positive correlation between VAF rate and LVM was noted (r = 0.40, p < 0.001). Subgroup analysis revealed the VAF ≥ 900 ml/min had risks of LVH 3.61, and 2.86 times compared with the non-VA group and the VAF < 900 ml/min group. After a 24-month follow up, there was no significantly individual change in LVMI in patients with or without VA except 6 patients who lost their VA patency during follow-up time had a significant reduction of LVMI (120.17 ± 52.13 to 80.89 ± 22.72 g/m2, p = 0.046).ConclusionsPatency of VA in post-KT patients was associated with LVH. There was a significant reduction of LMVI after loss of VA patency. Patients with stable kidney graft function should be considered for VA closure especially if VAF is ≥ 900 ml/min.

MO756: Roxadustat Versus Erythropoietin: Comparison of Efficacy in Reversing Ventricular Remodeling in Dialysis Patients with Anemia

Abstract BACKGROUND AND AIMS Renal anemia is one of the main complications of dialysis patients, which has been identified as an important independent risk factor for left ventricular hypertrophy and progression of heart failure, as well as adverse cardiovascular outcomes. Recent studies suggest that hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) Roxadustat represents a novel pharmacological treatment for renal anemia. This study aimed to compare the role of the Roxadustat and erythropoietin in reversing ventricular remodeling in dialysis patients with anemia. METHOD This was a retrospective cohort study that compared the treatment of Roxadustat and recombinant human erythropoietin (rhEPO) in dialysis patients for at least 24 weeks from January 2016 to October 2021. A total of 182 participants underwent echocardiography at least twice every 6 months. Baseline and follow-up examinations focused on the change of cardiac structure and function (doppler echocardiography), clinical and biochemical parameters and blood pressure. Participants were treated with oral iron supplements and controlled blood pressure (target value ≤ 130/80 mmHg). RESULTS Compared with baseline, left ventricular mass index (LVMI) decreased from 139.8 ± 36.0 to 126.5 ± 35.0 g/m2 (P&amp;lt;0.001) in the Roxadustat hemodialysis subgroup after 6-month treatment. Left ventricular end-diastolic diameters (LVEDd) and left ventricular wall thickness (LVPWT) were both significantly improved (from 5.13 ± 0.66 to 4.92 ± 0.65 cm; P= 0.002, and from 1.12 ± 0.17 to 1.07 ± 0.13 cm; P = 0.033, respectively). There was significant difference in LVMI before and after treatment in rhEPO group (from baseline 134.3 ± 36.8 to 131.8 ± 37.5 g/m2). There was greater reduction in LVMI from baseline to 6 months in Roxadustat group (–13.3 ± 22.4 g/m2 versus –5.02 ± 21.3 g/m2 for Roxadustat versus rhEPO; P= 0.028). In the peritoneal dialysis subgroups, Roxadustat also caused a significant improvement in LVMI and LVEDd (from baseline 133.9 ± 28.0 to 118.5 ± 28.2 g/m2; P= 0.001; from baseline 5.12 ± 0.55 to 4.86 ± 0.58 cm; P = 0.002). In addition, Roxadustat increased hemoglobin, serum albumin level and TIBC, and reduced the level of blood pressure, low density lipoprotein, TC and SF in Roxadustat hemodialysis subgroup. However, there were significant differences in the changes of systolic blood pressure, diastolic blood pressure and TIBC between the two hemodialysis groups. CONCLUSION In addition to the efficacy in the treatment of renal anemia, Roxadustat was found to be closely associated with improvement of LV diastolic function in dialysis patients. Our findings may provide new insights into anemia management in dialysis patients. Prospective clinical trials are necessary to further evaluate the role of Roxadustat or other HIF-PHIs in reversing ventricular remodeling.

The Predictive Value of Left Atrial Strain Following Transcatheter Aortic Valve Implantation on Anatomical and Functional Reverse Remodeling in a Multi-Modality Study.

IntroductionTranscatheter aortic valve implantation (TAVI) can improve left ventricular (LV) mechanics and survival. Data on the predictive value of left atrial (LA) strain following TAVI are scarce. We aimed to evaluate the association of LA strain measured shortly post-TAVI with functional and anatomical reverse remodeling of the LA and LV, and its association with mortality.MethodsWe prospectively investigated 90 patients who underwent TAVI. Transthoracic echocardiography including strain analysis was performed shortly after TAVI and repeated 6 months later. CT angiography (CTA) was performed for pre-TAVI planning and 6 months post-TAVI. Speckle tracking echocardiography was used to determine LA peak reservoir strain (LASr) and LV global longitudinal strain (LV-GL), LA volume index (LAVi) was measured by TTE. LV mass index (LVMi) was calculated using CTA images. LA reverse remodeling was based on LASr and LAVi changes, whereas LV reverse remodeling was defined as an improvement in LV-GLS or a reduction of LVMi. The association of severely reduced LASr (<20%) at baseline with changes (Δ) in LASr, LAVi, LV-GLS and LVMi were analyzed using linear regression, and Cox proportional hazard model for mortality.ResultsMean LASr and LV-GLS were 17.7 ± 8.4 and −15.3 ± 3.4% at baseline and 20.2 ± 10.2 and −16.6 ± 4.0% at follow-up (p = 0.024 and p < 0.001, respectively). Severely reduced LASr at baseline was associated with more pronounced ΔLASr (β = 5.24, p = 0.025) and LVMi reduction on follow-up (β = 5.78, p = 0.036), however, the majority of the patients had <20% LASr on follow-up (44.4%). Also, ΔLASr was associated with ΔLV-GLS (adjusted β = 2.10, p < 0.001). No significant difference in survival was found between patients with baseline severely reduced LASr (<20%) and higher LASr (≥20%) (p = 0.054).ConclusionLV reverse remodeling based on LVMi was present even in patients with severely reduced LASr following TAVI, although extensive LA damage based on LA strain was demonstrated by its limited improvement over time.Clinical Trial Registration(ClinicalTrials.gov number: NCT02826200).

Interaction between sex and left ventricular reverse remodeling and its association with outcomes after transcatheter aortic valve implantation

Women with severe aortic stenosis (AS) have better long-term prognosis after transcatheter aortic valve implantation (TAVI) compared to men. Whether this is caused by sex-related differences in left ventricular (LV) reverse remodeling after TAVI is unknown. Patients with severe AS who underwent transfemoral TAVI between 2007 and 2018 were selected. LV dimensions, volumes, and ejection fraction (LVEF) were assessed by transthoracic echocardiography before TAVI and at 6 and 12 months follow-up after TAVI. LV reverse remodeling was defined as the percentual LV mass index (LVMi) reduction compared to baseline. The primary outcome was all-cause mortality. A total of 459 patients (80 ± 8 years; 52% male) were included. At 6 and 12 months follow-up, both sexes showed significant reductions in LV volumes and LVMi accompanied by improvement in LVEF, without significant differences between the sexes over time. During a median follow-up of 2.8 [IQR 1.9–4.3] years, 181 (39%) patients died. Women showed better outcomes compared to men (log-rank p = 0.024). In addition, male sex was independently associated with all-cause mortality in multivariable Cox regression (HR 1.423, 95% CI 1.039–1.951, p = 0.028). No association was observed between the interaction of percentual LVMi reduction and sex with outcomes (p = 0.64). Men and women with severe AS had similar improvement in LVEF, and similar reductions in LV volumes and LVMi at 6 and 12 months after TAVI. Women showed better survival after TAVI as compared to men. The superior outcomes noted in women after TAVI are not associated with sex differences in LV reverse remodeling.Graphical abstract

Effect of amlodipine versus bisoprolol in hypertensive patients on maintenance hemodialysis: A randomized controlled trial.

Background:Left ventricular hypertrophy and asymmetric dimethylarginine (ADMA) are surrogate markers of cardiovascular disease (CVD) in the dialysis population. This study aimed to evaluate the effect of a calcium channel blocker-based antihypertensive regimen compared to a beta-blocker-based antihypertensive regimen on left ventricular mass index (LVMI) and ADMA levels in hypertensive patients on hemodialysis (HD).Methods:This was a parallel-design, open-label, single-center randomized controlled trial on 46 hypertensive patients on maintenance HD, with no history of CVD. Patients were randomly assigned to receive amlodipine 10 mg/d (n = 23) or bisoprolol 10 mg/d (n = 23). Office-based blood pressure (BP) was targeted to ≤ 140/ 90 mm Hg. The outcome was the change in LVMI and ADMA from baseline to 6 months.Results:Baseline demographic and clinical characteristics did not vary between groups. After 6 months of treatment, amlodipine-based therapy induced a greater reduction in LVMI from baseline than bisoprolol-based treatment (35 ± 34.2 vs 9.8 ± 35.9 gm/m2; P = .017). A similar reduction in the mean BP occurred with treatment in both groups. ADMA concentration decreased significantly from baseline in the amlodipine group (0.75 ± 0.73 to 0.65 ± 0.67 nmol/mL; P = .001), but increased nonsignificantly in the bisoprolol group (0.64 ± 0.61 to 0.78 ± 0.64 nmol/mL; P = .052).Conclusion:This study showed that compared to a bisoprolol-based regimen, an amlodipine-based antihypertensive regimen resulted in a significantly greater reduction in LVMI and ADMA levels from baseline in hypertensive patients on HD despite similar BP reduction in both groups. These findings support the re-evaluation of amlodipine as a potential first-line antihypertensive treatment in patients on HD without previous CVD.Trial Registration:Clinicaltrials.gov Identifier: NCT04085562, registered September 2019.